Ovarian cancer is the most lethal of gynecologic malignancies. Although African-American women have lower incidence rates than white women, their five-year survival rates are lower. To date, there has been little research on ovarian cancer in African-American women. In 1993, an analysis involving 110 cases and 365 controls was the first published report describing ovarian cancer risk factors in African-American women. An editorial accompanying this report called for further research on ovarian cancer in African-Americans, however there has been little progress in this area in the past fifteen years. In the international Ovarian Cancer Association Consortium, women of African descent comprise fewer than 300 of the more than 12,000 cases from 18 case-control studies, including 144 cases from our North Carolina Ovarian Cancer Study (NCOCS). Within the NCOCS, we have found evidence suggesting differences between African-Americans and whites in certain ovarian cancer risk factors including CAG repeats in the androgen receptor (AR) gene and anthropometric characteristics. Although these findings are intriguing, we have been unable to confirm them because of the paucity of data on African-American women in other studies. The purpose of this application is to establish a multi-center case-control study involving nine geographic regions within the United States to study the etiology of ovarian cancer in African Americans. The specific aims are: 1. To establish the infrastructure to recruit 1000 African-American women with invasive epithelial ovarian cancer and an equal number of age-matched controls. 2. To determine how risk factors for ovarian cancer in African-American women are similar or different to established risk factors for white women. We will calculate population attributable fractions to determine if differences in the prevalence of risk factors (e.g. reproductive characteristics or obesity) can account for racial differences in ovarian cancer incidence. 3. To evaluate genetic risk factors for ovarian cancer, focusing on concordance or discordance of results with genes that have been reported to be associated with ovarian cancer in white women in studies from large consortia or genome-wide association studies (GWAS). 4. To obtain information on treatment and outcome for ovarian cancer cases. We will analyze patterns of care and assess factors associated with obtaining treatment consistent with recommended standards for therapy. We also will be positioning ourselves to study predictors of survival among African-American ovarian cancer patients. The proposed study will fill an important gap in research on ovarian cancer in African-American women. Not only will we explore risk factors and prognostic characteristics that have been established as important in white women, we will investigate associations with factors that may be specific to African Americans. The large sample size and the diverse populations represented will provide critical insight into the similarities and differences in ovarian cancer risk factors between African-American and white women and may contribute to a better understanding of the poorer survival experienced by African Americans. PUBLIC HEALTH RELEVANCE: Although the epidemiology of ovarian cancer has been well-studied among Caucasian women there is very little known about risk factors for ovarian cancer among African-Americans. This is largely due to the sparse enrollment of African Americans in existing epidemiologic studies. The purpose of this study is to enroll 1,000 ovarian cancer cases and 1,000 controls of African American ethnicity from 9 geographic regions in the U.S. to comprehensively evaluate known and suspected epidemiologic and genetic factors for ovarian cancer in this population. The collection of treatment and follow-up data will set the stage to address the disparity in ovarian cancer survival among African-American women diagnosed with ovarian cancer compared to whites. This study will provide new insight into both the etiology and prognosis of ovarian cancer in African-American women.